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Laparoscopic transcystic common bile duct exploration versus transgastric endoscopic retrograde cholangiography during cholecystectomy after Roux-en-Y gastric bypass

Zaigham, Hassan LU orcid ; Enochsson, Lars ; Ottosson, Johan and Regnér, Sara LU orcid (2023) In Surgery for Obesity and Related Diseases 19(8). p.882-888
Abstract

Background: Treatment of common bile duct (CBD) stones after Roux-en-Y gastric bypass (RYGB) poses a particular challenge given the altered anatomy and inability to perform a standard endoscopic retrograde cholangiogram (ERC). The optimal treatment strategy for intraoperatively encountered CBD stones in post-RYGB patients has not been established. Objectives: To compare outcomes following laparoscopic transcystic common bile duct exploration (LTCBDE) and laparoscopy-assisted transgastric ERC for CBDs during cholecystectomy in RYGB-operated patients. Setting: Swedish nationwide multi-registry study. Methods: The Swedish Registry for Gallstone Surgery and ERCs, GallRiks (n = 215,670), and the Scandinavian Obesity Surgery Registry (SOReg)... (More)

Background: Treatment of common bile duct (CBD) stones after Roux-en-Y gastric bypass (RYGB) poses a particular challenge given the altered anatomy and inability to perform a standard endoscopic retrograde cholangiogram (ERC). The optimal treatment strategy for intraoperatively encountered CBD stones in post-RYGB patients has not been established. Objectives: To compare outcomes following laparoscopic transcystic common bile duct exploration (LTCBDE) and laparoscopy-assisted transgastric ERC for CBDs during cholecystectomy in RYGB-operated patients. Setting: Swedish nationwide multi-registry study. Methods: The Swedish Registry for Gallstone Surgery and ERCs, GallRiks (n = 215,670), and the Scandinavian Obesity Surgery Registry (SOReg) (n = 60,479) were cross-matched for cholecystectomies with intraoperatively encountered CBD stones in patients with previous RYGB surgery between 2011 and 2020. Results: Registry cross-matching found 550 patients. Both LTCBDE (n = 132) and transgastric ERC (n = 145) were comparable in terms of low rates of intraoperative adverse events (1% versus 2%) and postoperative adverse events within 30 days (16% versus 18%). LTCBDE required significantly shorter operating time (P = .005) by on average 31 minutes, 95% confidence interval (CI) [10.3–52.6], and was more often used for smaller stones <4 mm in size (30% versus 17%, P = .010). However, transgastric ERC was more often used in acute surgery (78% versus 63%, P = .006) and for larger stones >8 mm in size (25% versus 8%, P < .001). Conclusions: LTCBDE and transgastric ERC have similarly low complication rates for clearance of intraoperatively encountered CBD stones in RYGB-operated patients, but LTCBDE is faster while transgastric ERC is more often used in conjunction with larger bile duct stones.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adult, Adverse events, Cholangiopancreatography, Cholecystectomy, Choledocholithiasis, Endoscopic retrograde, Gastric bypass, Postoperative complications, Treatment outcome
in
Surgery for Obesity and Related Diseases
volume
19
issue
8
pages
882 - 888
publisher
Elsevier
external identifiers
  • pmid:36870871
  • scopus:85149720005
ISSN
1550-7289
DOI
10.1016/j.soard.2023.01.023
language
English
LU publication?
yes
id
e9b2d3ab-6362-489a-907f-8384cc86c562
date added to LUP
2023-04-03 11:03:06
date last changed
2024-04-18 09:36:31
@article{e9b2d3ab-6362-489a-907f-8384cc86c562,
  abstract     = {{<p>Background: Treatment of common bile duct (CBD) stones after Roux-en-Y gastric bypass (RYGB) poses a particular challenge given the altered anatomy and inability to perform a standard endoscopic retrograde cholangiogram (ERC). The optimal treatment strategy for intraoperatively encountered CBD stones in post-RYGB patients has not been established. Objectives: To compare outcomes following laparoscopic transcystic common bile duct exploration (LTCBDE) and laparoscopy-assisted transgastric ERC for CBDs during cholecystectomy in RYGB-operated patients. Setting: Swedish nationwide multi-registry study. Methods: The Swedish Registry for Gallstone Surgery and ERCs, GallRiks (n = 215,670), and the Scandinavian Obesity Surgery Registry (SOReg) (n = 60,479) were cross-matched for cholecystectomies with intraoperatively encountered CBD stones in patients with previous RYGB surgery between 2011 and 2020. Results: Registry cross-matching found 550 patients. Both LTCBDE (n = 132) and transgastric ERC (n = 145) were comparable in terms of low rates of intraoperative adverse events (1% versus 2%) and postoperative adverse events within 30 days (16% versus 18%). LTCBDE required significantly shorter operating time (P = .005) by on average 31 minutes, 95% confidence interval (CI) [10.3–52.6], and was more often used for smaller stones &lt;4 mm in size (30% versus 17%, P = .010). However, transgastric ERC was more often used in acute surgery (78% versus 63%, P = .006) and for larger stones &gt;8 mm in size (25% versus 8%, P &lt; .001). Conclusions: LTCBDE and transgastric ERC have similarly low complication rates for clearance of intraoperatively encountered CBD stones in RYGB-operated patients, but LTCBDE is faster while transgastric ERC is more often used in conjunction with larger bile duct stones.</p>}},
  author       = {{Zaigham, Hassan and Enochsson, Lars and Ottosson, Johan and Regnér, Sara}},
  issn         = {{1550-7289}},
  keywords     = {{Adult; Adverse events; Cholangiopancreatography; Cholecystectomy; Choledocholithiasis; Endoscopic retrograde; Gastric bypass; Postoperative complications; Treatment outcome}},
  language     = {{eng}},
  number       = {{8}},
  pages        = {{882--888}},
  publisher    = {{Elsevier}},
  series       = {{Surgery for Obesity and Related Diseases}},
  title        = {{Laparoscopic transcystic common bile duct exploration versus transgastric endoscopic retrograde cholangiography during cholecystectomy after Roux-en-Y gastric bypass}},
  url          = {{http://dx.doi.org/10.1016/j.soard.2023.01.023}},
  doi          = {{10.1016/j.soard.2023.01.023}},
  volume       = {{19}},
  year         = {{2023}},
}